Photography by Queenmoonlite35
Urinary Incontinence 101
Why it happens, what you can do, and when to seek help.
This article has been sponsored by Medtronic
Top things to know about urinary incontinence:
Urinary incontinence affects up to 45% of women
There are several types of incontinence, each with different causes and treatments
Pregnancy, birth, and aging all increase the risk
Urinary incontinence is common, but it’s not something you have to live with, and there are effective ways to manage and treat it
What is urinary incontinence?
Urinary incontinence (UI) is when someone leaks urine without meaning to. This can range from a few drops to a full bladder leak. It often happens because the muscles or nerves that help hold or release urine don’t work as they should (1).
UI is more common in women than in men, especially after birth or menopause (2). Despite how common it is, many people feel ashamed to talk about it. But incontinence isn’t something to hide—it’s a medical issue that can often be improved or treated. Left unaddressed, it can affect confidence, sleep, intimacy, and health (2).
How common is urinary incontinence?
You’re not alone—about 25–45% of women experience urinary incontinence (3). It tends to become more common later in life. Among women over 70, more than 40% are affected (3). Many cases go unreported due to shame or a lack of awareness that help is available, and most people affected do not seek medical help (4).
Symptoms can also look very different from person to person. They can occur as rarely as once a month or as often as daily. It may involve a few drops or a complete emptying of the bladder.
Types of urinary incontinence
Let’s break down the three main types of urinary incontinence:
1) Stress urinary incontinence (SUI)
Stress incontinence happens when pressure (from laughing, coughing, sneezing, or jumping) causes urine to unintentionally leak. It’s the most common type, especially in younger women (5). It’s usually caused by weakened pelvic floor muscles or urethral sphincters (the muscles that control when urine leaves the body). These muscles can weaken after birth, pelvic surgery, or nerve damage from diabetes (5,6).
Lower estrogen levels after menopause can also weaken the support around the urethra. Vaginal estrogen treatments can help, but oral estrogen could worsen symptoms (7-9).
2) Urgency urinary incontinence (UUI)
UUI happens when there is a sudden, strong need to pee, and the person can’t always make it to the bathroom in time. When a person who experiences UUI notices a sense of urgency, they will often need to empty their bladder right away, or it might empty accidentally. It can happen due to an overactive bladder muscle (called the detrusor muscle) (4,5). Sometimes people use the term overactive bladder (OAB) to describe UUI; however, UUI is only one of the common symptoms of an OAB.
3) Mixed type incontinence
This is when both stress and urgency symptoms occur together. It’s common and often treated by addressing both underlying causes (4,5).
What causes urinary incontinence?
Certain risk factors can influence the development of urinary incontinence. These include:
Pregnancy and birth
Pressure from a growing uterus and hormone changes can weaken bladder control. Up to 50% of people experience UI during pregnancy, and about 1 in 4 after vaginal birth. C-sections do carry a lower risk of UI but aren't completely without risk (6,10,11).
Age and menopause
As people age, the muscles around the bladder and urethra may weaken. After menopause, estrogen levels are lower. This may lead to thinning tissues and decreased structural support for the urethra. Aging alone doesn’t always cause incontinence. It’s common, but not typical for everyone (4,9,12).
Obesity
Extra body weight places pressure on the pelvic floor, which can lead to leaks (11,13).
High-impact exercise
Research has shown that female athletes, especially those participating in high-impact sports involving running or jumping, have a greater risk of urinary incontinence (14-16). This is thought to be related to repeated pressure on the pelvic floor muscles during intense activity, which can weaken the muscles over time (14-16).
Family history
Genetics may also play a role. If a close family member has incontinence, depending on the underlying cause, your risk may be higher too (11).
Smoking
Cigarette smoking may irritate the bladder and make symptoms worse. It’s also linked to chronic coughing, which increases internal pressure and may contribute to leakage (17).
Certain medical conditions
Certain medical conditions like multiple sclerosis, diabetes, and Parkinson’s disease, can increase the risk of experiencing urinary incontinence (18,19).
People with irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD) are also more likely to experience bladder symptoms, like urinary urgency or overactive bladder (20,21).
Obstetric fistulas
In some parts of the world with limited access to fast and high-quality medical care, long or difficult labor can cause a condition called obstetric fistula. This is a small opening (or tunnel) between the vagina and bladder or rectum. When the hole connects the bladder and vagina, it can lead to continuous urine leakage. Obstetric fistulae are a significant health concern globally, despite being rare in areas with widespread access to emergency obstetric services. This shows that not everyone has equal access to safe maternal healthcare (22,23).
Symptoms of UI
Urinary incontinence can affect people in many ways. Common symptoms include:
Leaking when coughing, laughing, or exercising
Leaking during sexual activity, such as during penetration or orgasm
A sudden, strong urge to pee and not making it in time
Waking up multiple times at night to urinate (nocturia)
Dribbling or needing to pee frequently, but only a small amount comes out
Accidents due to a physical difficulty getting to a toilet in time
Frequent urination (more than eight times per day) (4,24).
It’s also common to experience:
Wet underwear
Feelings of embarrassment or anxiety
Disruptions to daily life, sex, or sleep
When to see a healthcare provider
It’s time to seek medical attention if you notice any of the following:
Frequent leaking or accidents
You’ve stopped doing things you enjoy because of bladder control issues
Pain, burning, or blood in your urine
Needing to change pads or underwear often
Fever, chills, nausea, or vomiting
Pain in your lower back or sides (4,24)
These symptoms could also signal another underlying condition, so it’s important to get medical attention and support.
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How is urinary incontinence treated?
There’s no one-size-fits-all solution—each situation deserves its own approach.
Your healthcare provider will start by talking with you about your symptoms and how they affect your daily life. They may ask you to keep a bladder diary for a few days, noting how often you urinate, how urgent the need feels, and how much you drink and urinate. This helps identify patterns and possible causes.
Your doctor might also suggest a urogynecological exam to check for any physical factors that could be contributing.
Based on what they find, your care team can create a personalized treatment plan, starting with simple, low-risk steps and moving to other options if needed.
You can also track what you notice in the Clue app under Urine, including frequent urination, burning sensation, and leaks or dribbles. Keeping track of these changes over time can help you and your healthcare provider understand what’s happening in your body.
Lifestyle changes
Making small adjustments to your daily routine can help reduce bladder leaks, especially for stress and urgency incontinence. These strategies are often recommended as a first step and are easy to try at home (3,24,25).
Fluid intake: Try drinking small amounts of fluid regularly throughout the day. Drinking large volumes at once or late at night can increase the chance of leaks. Most people do well with around 1.5–2 liters per day. If your urine is very pale or clear, you may be drinking more than you need (24).
Limit caffeine and alcohol: Both can irritate the bladder and make urgency symptoms worse (24).
Adjust evening habits: If you leak at night or wake up frequently to urinate, it may help to reduce fluids 2–3 hours before bedtime (24).
Maintain a healthy weight: Carrying extra weight can place more pressure on the pelvic floor and bladder. Losing just 5–10% of your body weight can significantly reduce leaks, especially for stress incontinence (24,26).
Manage dietary triggers and bowel health: Spicy foods, acidic foods, and constipation can sometimes trigger urgency. Managing your fiber intake and avoiding known dietary triggers may help.
Physical therapy
Pelvic physical therapy focuses on improving the strength and coordination of the muscles that support the bladder, uterus, and digestive system. It’s very effective (especially for stress and mixed incontinence) and often involves more than just kegels (3,24,26,27).
Pelvic floor exercises (kegels): These exercises strengthen the muscles that help control urine flow. When done correctly and consistently, they can improve or resolve symptoms (26).
Finding the right muscles: Some people unknowingly use the wrong muscles when doing kegels. A pelvic floor physical therapist can help with technique. You can also use in-home biofeedback tools that give real-time feedback on your muscle contractions (24,27).
Advanced support: Therapists may also guide you through core muscle training, breathing techniques, or manual therapy. These will improve posture, muscle coordination, and pressure management, which all support continence (24).
Bladder training: This technique helps teach the bladder to hold urine longer and reduce sudden urges. It usually involves going to the toilet at set times and gradually increasing the time between bathroom trips. Over time, this can reduce leaks and help restore normal patterns (4,24).
Medical devices
A pessary is a soft device placed in the vagina to support the bladder and reduce stress incontinence (4,24).
There’s also an over-the-counter insert (like a tampon) designed to help prevent leaks during physical activity (4,24).
Medications for urgency urinary incontinence
There are many medications available to help reduce the symptoms of UUI and OAB, including:
Bladder relaxants (like oxybutynin) help reduce urgency and frequency (24,25). These often come available as pills or patches.
Mirabegron lets the bladder hold more urine and can ease urgency symptoms (24,25).
Vaginal estrogen (cream or insert) may help with incontinence related to menopause or vaginal atrophy (24).
Specialized procedures for urgency urinary incontinence
When other treatments have not worked or are not an option for you, nerve stimulation may be considered. These include:
Percutaneous tibial nerve stimulation (PTNS) is a needle-based therapy (like acupuncture with a small electric signal) done near the ankle to influence bladder function over time (24).
Sacral neuromodulation (SNM) uses a small device to send gentle electrical signals to the nerves that help control the bladder (24).
Botox (onabotulinumtoxinA) injections into the bladder can calm overactive bladder signals (24,25).
Surgery for stress urinary incontinence
The following surgical procedures may help treat SUI:
Slings (often made from synthetic mesh) are placed under the urethra to provide support (4,24).
Colposuspension is a procedure where stitches are placed on either side of the bladder neck to lift the urethra to help reduce urine leakage (24).
If surgery is not an option or hasn’t worked, urethral bulking is another option. This is an injection of a synthetic material to “plump” the opening of the urethra, which may reduce leaks (24).
What can I do to prevent urinary incontinence?
The following steps won’t prevent all cases of UI, but they can reduce risk and improve symptoms. Being aware of these steps is especially helpful if you are at a higher risk of IU.
Do pelvic floor exercises regularly and correctly
Maintain a healthy weight
Limit caffeine and alcohol intake
Stay hydrated
Avoid or limit eating spicy or acidic foods
Avoid lifting heavy objects
Decrease or avoid smoking (24,26)
You’re not alone
Urinary incontinence is common, especially for women during times of change like pregnancy or menopause. But it isn’t something you have to live with quietly or feel ashamed about.
Understanding what’s happening in your body—and tracking it—can help you take back control. If you’re experiencing symptoms of urgency incontinence (like sudden urges, leaks, or frequent trips to the toilet), this patient decision aid from the Support Incontinence Foundation can be helpful. It walks you through different management options and can help support conversations with your healthcare provider. Talk to your provider, explore treatment options, and remember: support is out there.
FAQs
Is urinary incontinence permanent?
Not always. Many people get much better, or even recover completely, with pelvic floor exercises and lifestyle changes (25,26). However, further options (like medication, sacral neuromodulation, and Botox) often have greater clinical efficacy, and it is recommended that you find the solution that works best for you.
At what age does urinary incontinence typically begin?
It can start at any age, but it does become more common with aging, as the muscles that control the bladder can weaken over time. Stress incontinence is more common in pregnancy (3,25).
How can I tell if I’m leaking urine or discharge?
Vaginal discharge is often clear or white and thicker in consistency than urine. If you’re unsure whether you’re leaking urine or experiencing vaginal discharge, a healthcare provider can help you understand what’s typical and when to seek care (25).
Why is my underwear always wet with urine?
This may be a sign of light urinary incontinence, which could be from stress or urgency incontinence. A healthcare provider can help assess and treat the cause.
What is “coital” incontinence?
Some people leak urine during sex, which is known as coital incontinence. It can happen during penetration (usually linked to stress incontinence) or at orgasm (more often linked to urgency incontinence) (28). While it’s not often talked about, it’s relatively common and can often improve with the right treatment for the underlying incontinence type.
What is “overflow” incontinence?
Overflow incontinence happens when the bladder doesn’t empty fully, and small leaks occur later. It’s less common and may be caused by things like nerve damage, pelvic surgery, or something blocking the flow of urine (4). It often feels like dribbling or incomplete emptying and may need medical treatment to manage.
What is functional incontinence?
Functional incontinence isn’t about the bladder itself—it happens when something else prevents you from reaching the toilet in time, like a mobility issue, injury, or cognitive condition such as dementia (4). It’s more common in older adults or people with disabilities.
What is reflex incontinence?
Reflex urinary incontinence is when the body leaks urine without warning or the urge to go. This often happens due to nerve damage and is usually linked to neurological conditions (29). It’s less common and typically requires medical evaluation and support.
